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It takes two

Author: Laurie Wertich

Cancer treatment can present a long and winding
road, marked by emotional and physical challenges
along the way. Though the prospect may
seem daunting, building good rapport with your
doctor can help make that journey a smooth one. In fact, many
patients report that building a healthy patient/physician relationship
had a positive impact on their treatment.
But how can you cultivate a solid relationship with a busy
doctor who has an endless list of patients to see? Actually, it’s not
all that different from any relationship; a little respect and communication
go a long way.

The patient/physician relationship

Once upon a time, the medical system operated on the premise
that “doctors know best.” Patients visited doctors, doctors gave
orders, and patients generally followed those orders without question.
The doctor was an authority figure, and the patient/physician
relationship most often resembled a child/parent relationship.

But a new era has dawned: a look at patient/physician relationships
today shows us that we are shifting from a model wherein
the doctor is the authority to one in which he or she occupies
the role of expert consultant and, ideally, partner, alongside an
empowered and educated patient. This evolution places the
patient firmly in the driver’s seat, an active participant on the
treatment journey.

People relating to people

Shayma Kazmi, MD, a hematologist-oncologist and medical oncologist
at Cancer Treatment Centers of America® (CTCA) in
Philadelphia, Pennsylvania, strives to encourage this new model
of partnership in her work with patients.

Key to this effort, Dr. Kazmi says, is building relationships
with her patients. “It’s important to try to get to know the patient,”
she explains. “They’re not just about the cancer. There is
so much more going on that may not have anything to do with
cancer. The more you learn, the better you can treat them.” When she meets new patients, Dr.
Kazmi tries to learn how they do things
at home, what is important to them, what
kind of family obligations they have, and
more. “If you don’t know all of that, you
miss a big opportunity to treat them
fully,” she insists.

Dr. Kazmi believes it is critical for both
patients and doctors to be as frank and
open as possible. Sometimes patients are
afraid to tell their doctors certain things,
but Dr. Kazmi says that the more she
knows, the better she can help. “This is
about the disease and your treatment,
and I’m here to help you,” she tells patients.
“You can do whatever you choose.
You’re empowered, and I respect that.”

As a patient of Dr. Kazmi’s, Pam
Cromwell, a business analyst from New
Jersey, can attest to the positive impact of
her doctor’s efforts to connect on a personal
level. Though Pam is currently living
with stage IV breast cancer, she jokes
that her “Jedi mind trick” allows her to
fake it much of the time and forget that
she has cancer—except when she sees Dr.
Kazmi. “Dr. Kazmi sees me at my most
flawed,” Pam says. “Other people see me
as Pam the businesswoman or Pam the
church girl, but she sees me as Pam the
cancer patient, and that’s where I’m most
vulnerable.”

For Pam this vulnerability is the key
to her relationship with Dr. Kazmi. She
feels a certain sense of safety and comfort
with Dr. Kazmi that she hasn’t experienced
with other doctors. “Anyone can go
through the proper education to become
a doctor, but not everyone has the true
compassion to be a doctor,” explains Pam.
Right away Pam knew that Dr. Kazmi
was different. “She won me over with her
honesty,” Pam recalls. “It was sincere honesty.
She was real about what I was going through, what her knowledge was, and every option she gave
me. She never gave me that 100 percent guarantee.”

From there the relationship unfolded. Pam found a place
where she could be real. She let her guard down, she cried, she
asked questions, and she shared her fears. She also found the
strength to keep enjoying her life. Both Pam and Dr. Kazmi
recount the story of Pam’s new kickboxing habit. “I will never
forget the look on Dr. Kazmi’s face when I told her that I had
started kickboxing,” Pam laughs. “People with cancer in their
bones probably shouldn’t be kickboxing.”

Dr. Kazmi took it in stride. “Pam told me that she really enjoyed
it and that it made her feel like a real person,” Dr. Kazmi
recalls. “I just sat back and laughed and told her that as long as
she was very careful, it was okay. She knows I’d rather she didn’t
do it, but I’d rather know about it. If it’s important to her, it’s
okay with me.”

This kind of openness between doctors and patients is critical,
Dr. Kazmi says: “The more open they can be, the more you can
learn and the more you can enhance treatment.”
Dr. Kazmi makes this sense of openness a priority. She wants
her patients to be able to live as normal a life as possible. Pam
sensed this—she felt like she really mattered and that Dr. Kazmi
wanted the best for her. “I need the warm and fuzzy,” Pam says,
“and I need to know that I’m not just a number. I know she has a
full life. She has many, many patients. But she’ll take 45 minutes
to an hour with me and never makes me feel like I need to rush
or like I’m messing up someone else’s appointment.”

Perhaps the bottom line is that Pam simply felt comfortable with Dr. Kazmi, and Dr. Kazmi says this
might be the most important part of the
patient/physician relationship. “If you’re
not comfortable with a physician, don’t
feel like it’s rude or insulting to switch,”
she urges. “It’s your life. They’re not going
to get offended and, frankly, if they
do, who cares?”

Communication is key

As is clear in the case of Pam and Dr.
Kazmi, a healthy patient/physician relationship
requires a desire on the part
of both parties to listen and to be heard.
Dennis Citrin, MD, PhD, a medical oncologist
at CTCA in Zion, Illinois, believes
that this type of communication is the key
to fostering healthy relationships with patients.
“A patient/physician relationship is
like any relationship: there has to be good
and honest communication between the
people involved,” Dr. Citrin says.

This communication forms the cornerstone
of Dr. Citrin’s relationships with
patients. “I always encourage patients to
ask questions and really understand the
answers they get,” he explains. “The more
they understand about their situation,
the easier my job becomes.”

He sees the patient/physician relationship
as one based in mutual respect.
Although he may be the cancer expert, his
patients are experts regarding their own
lives and needs—and the patient is the focus.
“The patient’s welfare is paramount.
That is the most important element,” Dr.
Citrin insists. “I listen, answer questions,
and offer support—and the relationship
evolves from that.”

Terrece Crawford, a busy single
mom and an art teacher from Kenosha,
Wisconsin, is a patient of Dr. Citrin’s, and
she has seen firsthand the positive experience
of solid communication built on a
foundation of respect.

When she was diagnosed with stage II
invasive ductal carcinoma, Terrece says
she initially felt as though her life came to
an abrupt halt. All she could think about
was her children. “I didn’t even care about
myself at that moment,” she recalls. “I just
thought, I have to be here for my children.”
The sense of fear she felt was overwhelming—
until she met Dr. Citrin.

“Dr. Citrin was so kind and compassionate.
He told me I had hope, but I didn’t
believe him,” Terrece recounts. “But he is
a wise doctor. He understands people. He
leaned in closer, looked me in the eye, and
said, ‘You do have hope, and you are going
to be okay.’ That was a turning point for
me.”

“Terrece had early-stage breast cancer, so
her prognosis was excellent, but her treatment
and follow-up is a long journey,” Dr.
Citrin explains. This long journey provided
the opportunity for the two to develop a
solid patient/physician relationship.
“Some patients are more guarded, but
Terrece came to look on the team here as
being a very important resource for her
in terms of support,” Dr. Citrin says. “The
environment we provide here is pretty
unique. We encourage patients to express
themselves, ask questions, and understand
the answers they get.”

By empowering Terrece as a patient, Dr.
Citrin opened the door to building a solid
working relationship. “Dr. Citrin took time
with me, and I did not feel rushed,” Terrece
says. “I opened up to him because it would
help him understand me. He wanted to
know that I was okay as a person, and that
helped me feel like I mattered. It was not
just about cancer: as his patient, it was
about being a person.”

At the beginning of her cancer journey,
Terrece painted a self-portrait and showed
it to Dr. Citrin. “He told me, ‘That’s what I
like to see: patients doing something positive
about their journey,’” Terrece recalls.
She had been feeling shy and insecure
about her talent, but the positive feedback
from Dr. Citrin encouraged her. By the
end of her treatment, Terrece had created
25 works of art, including self-portraits to
document her journey.

In it together

Your doctor knows cancer, but you are
more than your cancer. When you reveal
the real you and ask questions and share
your hopes and fears, you give your doctor
an opportunity to know you—and this
can help guide treatment. Remember that
you’re both on the same team, and you
both have the same goal: to beat cancer.
Keep it real, communicate clearly, and establish
a level of mutual respect. Together
you and your doctor can navigate cancer.

No case is typical. You should not expect to experience
these results.